{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T13:46:12Z","timestamp":1769867172160,"version":"3.49.0"},"reference-count":12,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T00:00:00Z","timestamp":1747094400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Plast Surg"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Complex vulvar defects are challenging owing to their three-dimensional characteristics. We introduce a combined flap approach to maximize the use of locoregional tissues. Four patients had defects involving the vaginal wall, anal canal, and perineum, with a size range of 108 to 157\u2009cm2. The outcomes were analyzed using a questionnaire regarding micturition, defecation, coital function, introitus opening, and aesthetics. For the vulva, the gluteal fold flap was the primary flap, which was augmented by the mons pubis rotation flap, gracilis muscle flap, pudendal thigh flap, and medial thigh VY advancement flap. The perianal skin and anal defects were covered by the gluteal fold and buttock VY advancement flaps. Patients' satisfaction scores were favorable on follow-up. Our multi-flap approach optimized the aesthetic and functional results of combined vulvar\u2013anal defects.<\/jats:p>","DOI":"10.1055\/a-2606-9515","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T19:19:18Z","timestamp":1747163958000},"page":"045-051","source":"Crossref","is-referenced-by-count":0,"title":["Overcoming the Three-Dimensional Complexity of Vulvar Defects: A Stepwise, Multi-Flap Approach"],"prefix":"10.1055","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0703-8522","authenticated-orcid":false,"given":"Chuan-Han","family":"Ang","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive, and Aesthetic Surgery, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4845-8033","authenticated-orcid":false,"given":"Walter J.X.","family":"Tan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7347-8713","authenticated-orcid":false,"given":"Bien-Keem","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive, and Aesthetic Surgery, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1050-1613","authenticated-orcid":false,"given":"Khong-Yik","family":"Chew","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive, and Aesthetic Surgery, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,7,11]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"379","DOI":"10.5999\/aps.2014.41.4.379","article-title":"Subunit principle of vulvar reconstruction: algorithm and outcomes","volume":"41","author":"B K Tan","year":"2014","journal-title":"Arch Plast Surg"},{"issue":"12","key":"ref2","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1111\/j.1471-0528.2011.03080.x","article-title":"A long-term prospective study to compare the effects of vaginal and abdominal hysterectomy on micturition and defecation","volume":"118","author":"M M Lakeman","year":"2011","journal-title":"BJOG"},{"issue":"08","key":"ref3","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1111\/1471-0528.13975","article-title":"Pelvic organ function before and after laparoscopic bowel resection for rectosigmoid endometriosis: a prospective, observational study","volume":"123","author":"M Riiskjaer","year":"2016","journal-title":"BJOG"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1136\/ijgc-00009577-200605000-00027","article-title":"An observational longitudinal study to evaluate miction, defecation, and sexual function after radical hysterectomy with pelvic lymphadenectomy for early-stage cervical cancer","volume":"16","author":"Q D Pieterse","year":"2006","journal-title":"Int J Gynecol Cancer"},{"issue":"07","key":"ref5","doi-asserted-by":"crossref","first-page":"1998","DOI":"10.1097\/00006534-200112000-00025","article-title":"The gluteal-fold flap for vulvar and buttock reconstruction: anatomic study and adjustment of flap volume","volume":"108","author":"I Hashimoto","year":"2001","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1097\/01.prs.0000227683.47836.28","article-title":"Gluteal fold V-Y advancement flap for vulvar and vaginal reconstruction: a new flap","volume":"118","author":"P K Lee","year":"2006","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1097\/00006534-198904000-00018","article-title":"A new technique of vaginal reconstruction using neurovascular pudendal-thigh flaps: a preliminary report","volume":"83","author":"J T Wee","year":"1989","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1097\/SAP.0000000000003597","article-title":"A simplified algorithmic approach to vulvar reconstruction according to various types of vulvar defects","volume":"91","author":"W Y Han","year":"2023","journal-title":"Ann Plast Surg"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"461","DOI":"10.5999\/aps.2016.43.5.461","article-title":"Three-directional reconstruction of a massive perineal defect after wide local excision of extramammary Paget's disease","volume":"43","author":"S W Cho","year":"2016","journal-title":"Arch Plast Surg"},{"issue":"05","key":"ref10","doi-asserted-by":"crossref","first-page":"1939","DOI":"10.1097\/PRS.0b013e31820e9223","article-title":"Anterolateral thigh flap-based reconstruction for oncologic vulvar defects","volume":"127","author":"A Zeng","year":"2011","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref11","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1055\/s-0032-1333322","article-title":"Split and thinned pedicle deep inferior epigastric perforator (DIEP) flap for vulvar reconstruction","volume":"29","author":"A Cheng","year":"2013","journal-title":"J Reconstr Microsurg"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"277","DOI":"10.5999\/aps.2018.00416","article-title":"Gracilis pull-through flap for the repair of a recalcitrant recto-vaginal fistula","volume":"46","author":"W L James Mok","year":"2019","journal-title":"Arch Plast Surg"}],"container-title":["Archives of Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2606-9515.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T23:43:20Z","timestamp":1769816600000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2606-9515"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,13]]},"references-count":12,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2026,1,30]]},"published-print":{"date-parts":[[2026,1]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2606-9515","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2234-6163","2234-6171"],"issn-type":[{"value":"2234-6163","type":"print"},{"value":"2234-6171","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,5,13]]},"published":{"date-parts":[[2025,5,13]]}}}